Examining suicidality in relation to the menopause: A systematic review

Area of Science:

• Reproductive Health
• Mental Health
• Epidemiology

Background:

• Suicide is a leading global cause of death, with women experiencing more attempts and midlife women having the highest death rates.
• The potential link between menopause and suicidality warrants investigation due to midlife women's elevated suicide mortality.
• Existing literature on menopause and suicidality requires a comprehensive synthesis to clarify the relationship.

Purpose of the Study:

• To systematically review existing literature on the relationship between menopause and suicidality.
• To synthesize current evidence regarding menopause stages and their association with suicidal ideation and behavior.
• To identify gaps and limitations in the current research landscape.

Main Methods:

• Systematic literature search across major databases (MEDLINE, Cochrane, Scopus, Web of Science, PsycINFO, Embase) in October 2023.
• Independent screening of titles, abstracts, and full texts by two authors, with discrepancies resolved through discussion.
• Risk of bias assessment using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) and narrative/tabulated data summarization.

Main Results:

• A total of 28 studies met the inclusion criteria, revealing a complex and often contradictory relationship between menopause and suicidality.
• Some studies indicated higher suicidal thoughts during perimenopause, while others found increased suicidality in post-menopausal or pre-menopausal individuals, or those with primary ovarian insufficiency.
• Critically, several studies found no significant link between hormonal status and suicidality, and a consistent methodological flaw was the lack of lived experience involvement.

Conclusions:

• The current evidence base on the relationship between menopause and suicidality is mixed and inconclusive.
• The perimenopause, post-menopause, and pre-menopause stages have shown varied associations with suicidality across studies.
• Further high-quality research, incorporating lived experience, is essential to elucidate the complex interplay between menopause and suicidality.